Katherine Verdolini Abbott

The Frequency of Perceived Stress, Anxiety, and Depression in Patients with Common Pathologies Affecting Voice

The studys objectives were to investigate (1) the frequency of perceived stress, anxiety, and depression for patients with common voice disorders, (2) the distribution of these variables by diagnosis, and (3) the distribution of the variables by gender. Retrospective data were derived from self-report questionnaires assessing recent stress (Perceived Stress Scale-10), anxiety, and depression (Hospital Anxiety and Depression Scale) in a cohort of new patients presenting to a voice clinic. Data are presented on 160 patients with muscle tension dysphonia (MTD), benign vocal fold lesions, paradoxical vocal fold movement disorder (PVFMD), or glottal insufficiency. Pooled data indicated that average stress, anxiety, and depression scores were similar to those found for the healthy population. However, 25.0%, 36.9%, and 31.2% of patients showed elevated stress, anxiety, and depression scores, respectively, compared to norms. Patients with PVFMD had the most frequent occurrence-and patients with glottal insufficiency had the least frequent occurrence of elevated stress, anxiety, and depression. Stress and depression were more common with MTD than with lesions, whereas reverse results were obtained for anxiety. More females than males had elevated stress, anxiety, and depression scores. The data are consistent with suggestions that stress, anxiety, and depression may be common among some patients with PVFMD, MTD, and vocal fold lesions and more common for women than men. However, individual variability in the data set was large. Further studies should evaluate the specific role of these conditions for selected categories of voice disorders in susceptible individuals.

Preliminary data on two voice therapy interventions in the treatment of presbyphonia

Presbyphonia is common among elderly individuals, yet few studies have evaluated behavioral treatment approaches for presbyphonia. The primary aim of this study was to assess the short‐term efficacy of two types of voice therapy—vocal function exercises (VFE) and phonation resistance training exercise (PhoRTE) therapy—in the treatment of presbyphonia. The secondary aim was to determine if differences in adherence and treatment satisfaction existed between the two therapy approaches.

Behavioral Treatment of Voice Disorders in Teachers

Introduction: The purpose of this paper is to review the literature on the behavioral treatment of voice disorders in teachers. The focus is on phonogenic disorders, that is voice disorders thought to be caused by voice use. Methods: Review of the literature and commentary. Results: The review exposes distinct holes in the literature on the treatment of voice problems in teachers. However, emerging trends in treatment are noted. For example, most studies identified for review implemented a multiple-therapy approach in a group setting, in contrast to only a few studies that assessed a single-therapy approach with individual patients. Although the review reveals that the evidence around behavioral treatment of voice disorders in teachers is mixed, a growing body of data provides some indicators on how effectively rehabilitation of teachers with phonogenic voice problems might be approached. Specifically, voice amplification demonstrates promise as a beneficial type of indirect therapy and vocal function exercises as well as resonant voice therapy show possible benefits as direct therapies. Finally, only a few studies identified even remotely begin to meet guidelines of the Consolidated Standards of Reporting Trials statement, a finding that emphasizes the need to increase the number of investigations that adhere to strict research standards. Conclusions: Although data on the treatment of voice problems in teachers are still limited in the literature, emerging trends are noted. The accumulation of sufficient studies will ultimately provide useful evidence about this societally important issue.

Vocal Fatigue Index (VFI): Development and Validation

OBJECTIVE To develop a psychometrically sound self-report questionnaire, the Vocal Fatigue Index (VFI), to help identify individuals with vocal fatigue (VF) and characterize their complaints. STUDY DESIGN Descriptive research-scale development. METHODS Four laryngologists and six speech-language pathologists specialized in voice created a beta version of the VFI (version 1), an index of 21 statements they considered to reflect VF. Two hundred patients presenting to two different clinics completed the VFI-1. Two items from VFI-1 were excluded because of poor item-to-total correlations. The final VFI of 19 items (version 2), completed by 105 patients with voice complaints and 70 vocally healthy individuals, was assessed for its psychometric properties. RESULTS Test-retest reliability for the final VFI was generally strong, as was sensitivity and specificity using the classification table under logistic regression for correctly distinguishing individuals with and without VF. Moreover, factor analysis indicated that VF may be characterized by three factors: (1) factor 1, related to tiredness of voice and voice avoidance, (2) factor 2, related to physical discomfort associated with voicing, and (3) factor 3, related to improvement of symptoms with rest. CONCLUSION The VFI is a standardized tool that can identify individuals with probable VF with good reliability, validity, sensitivity, and specificity.

Biosimulation of inflammation and healing in surgically injured vocal folds.

Objectives The pathogenesis of vocal fold scarring is complex and remains to be deciphered. The current study is part of research endeavors aimed at applying systems biology approaches to address the complex biological processes involved in the pathogenesis of vocal fold scarring and other lesions affecting the larynx. Methods We developed a computational agent-based model (ABM) to quantitatively characterize multiple cellular and molecular interactions involved in inflammation and healing in vocal fold mucosa after surgical trauma. The ABM was calibrated with empirical data on inflammatory mediators (eg, tumor necrosis factor) and extracellular matrix components (eg, hyaluronan) from published studies on surgical vocal fold injury in the rat population. Results The simulation results reproduced and predicted trajectories seen in the empirical data from the animals. Moreover, the ABM studies suggested that hyaluronan fragments might be the clinical surrogate of tissue damage, a key variable that in these simulations both is enhanced by and further induces inflammation. Conclusions A relatively simple ABM such as the one reported in this study can provide new understanding of laryngeal wound healing and generate working hypotheses for further wet-lab studies.

Intrinsic laryngeal muscle activity in response to autonomic nervous system activation

To determine whether the intrinsic laryngeal muscles exhibit a response to induced autonomic nervous system (ANS) activation, and to characterize responses that may occur.

Translational systems biology and voice pathophysiology.

Personalized medicine has been called upon to tailor healthcare to an individuals needs. Evidence‐based medicine (EBM) has advocated using randomized clinical trials with large populations to evaluate treatment effects. However, due to large variations across patients, the results are likely not to apply to an individual patient. We suggest that a complementary, systems biology approach using computational modeling may help tackle biological complexity in order to improve ultimate patient care. The purpose of the article is: 1) to review the pros and cons of EBM, and 2) to discuss the alternative systems biology method and present its utility in clinical voice research.

Biosimulation of acute phonotrauma: An extended model†

Personalized, preemptive, and predictive medicine is a central goal of contemporary medical care. The central aim of the present study was to investigate the utility of mechanistic computational modeling of inflammation and healing to address personalized therapy for patients with acute phonotrauma.

Role of steroids in acute phonotrauma: A basic science investigation.

Steroids are used for the treatment of laryngitis in vocal performers and other individuals despite the absence of evidence demonstrating their impact on vocal fold inflammation. Our objective was to examine laryngeal secretion cytokine inflammatory profile changes associated with corticosteroid treatment in a human phonotrauma model.

The Influence of Clinical Terminology on Self-Efficacy for Voice

Abstract Self-efficacy is defined as ones belief in ones ability to carry out a specific behavior successfully. The current studys objective is to obtain initial evidence in support of the hypothesis that the terms ‘vocal abuse/misuse’ have the potential to harm self-efficacy for voice and may impact adherence with therapeutic directives. Teachers with voice problems were exposed to the terms ‘abuse/misuse’ or ‘phonotrauma/muscle tension’ as describing the origin of common voice problems. Pre- and post-exposures, subjects completed a Voice Self-Efficacy Questionnaire that was specially designed for the study. Results provide preliminary support for the hypothesis that clinical exposure to ‘abuse/misuse’ terminology may harm normal increases in self-efficacy for voice that are generally expected following education about medical conditions.